Just heard this from our friends at the National Health Law Program: Health Care Reform Victory: Court Upholds Constitutionality of ACA
More details from NY Times : Appeals Court Backs Health Care Law
Archive for the ‘Health Care Marketing’ Category
Breaking News: Court Upholds Constitutionality of ACA
Posted in Health Care Marketing on 8 November 2011 | Leave a Comment »
Backward step of the day: Tobacco companies 1 : Public Health 0
Posted in Health Care Marketing on 7 November 2011 | Leave a Comment »
Should we take up a collection for the tobacco companies whose claims that they would suffer “irreparable harm” ( and a cost of $20M) if required to redesign all of their cigarette packaging, were upheld today in a ruling by U.S. District Court Judge Richard Leon? Judge Leon’s action 
Health News Progress Report
Posted in Advocacy, Conflicts of Interest, Consumer Protection, Economics of Health Care, Ethics, Global Health, Health Care Marketing, Health Insurance, Military medicine, Promotions, State of Washington, Tobacco control on 17 August 2011 | 1 Comment »
Moving forward
Regence fined $100K for denying women coverage
[Washington] State Insurance Commissioner Mike Kreidler has fined Regence BlueShield $100,000 for denying contraceptive coverage to 984 women.
Regence had covered the women’s use of an IUD, or intrauterine contraceptive device, but not the removal of it. When the women wanted to remove the device because it was outdated, or because they wanted to get pregnant, the insurance giant did not consider those reasons as “medically necessary,” state officials said Monday.
“There’s an important lesson here,” Kreidler said in a statement.
“If you believe you’ve been unjustly denied coverage, don’t just accept it, call us. Of the 984 women who were denied contraceptive coverage by Regence, only three appealed the decision – and all the denials were upheld.”
He said one woman’s call to his office resulted in coverage for nearly a thousand other women who were denied coverage over the span of eight years.
Going backward
Tobacco Giants Sue to Block Graphic Warning Labels
Five tobacco companies have filed suit against the U.S. government claiming that government-ordered graphic warning labels on cigarette packs violate their First Amendment rights.
Starting on Sept. 22, 2012, cigarettes sold in the U.S. will have to carry graphic images warning of the dangers of smoking. These images include a tracheotomy hole, rotting teeth, diseased lungs, and a body on an autopsy table.
The images will be accompanied by dissuasive wording on cigarettes and smoking, including “cigarettes are addictive,” “cigarettes cause cancer,” and “smoking can kill you.” They must be displayed on at least half of the front and back of cigarette packs, and 20% of the top of the pack.
The lawsuit was filed by four of the nation’s largest tobacco companies — including R.J. Reynolds Tobacco and Lorillard, and one smaller company (Sante Fe Natural Tobacco Company) — against the FDA and the Department of Health and Human Services.
The companies are seeking to prevent enforcement of the images, arguing that the government cannot legally force them to espouse an anti-smoking advocacy message….
This is yet another area of health promotion in which the US has long fallen short. Graphic warning labels on cigarette packs have been used in Canada since 2001, and dozens of other countries have followed suit.
A bit of both, local news that is national :
Army whistle-blower fights to clear name
Madigan Army Medical Center surgeon Michael Eisenhauer says his military career foundered as he exposed cozy dealings between an Army doctor and a medical-equipment manufacturer. His whistle-blowing helped lead to the criminal conviction of one doctor; but Eisenhauer is still fighting to clear his own name.
Eisenhauer detailed a cozy relationship between the medical-equipment manufacturer Boston Scientific and two Madigan cardiologists, who insisted on sole-source purchases of that company’s implant devices.
<snip>
The long-standing practice of drug companies and medical-equipment manufacturers offering doctors free trips, speaking honorariums and other payments is controversial. Critics say the money may often represent kickbacks for favoring a company’s drugs or devices.
Still, in civilian practices such payments are generally considered legal. In the military, however, doctors are prohibited from taking such payments.
“Military doctors must owe their allegiance to the soldiers and families they treat — not to drug companies or makers of medical devices,” said U.S. Attorney Jenny Durkan in a statement announcing the plea deal reached with Davis.
“That is why we have a bright line rule: doctors employed by the government cannot accept payments or gratuities from an outside source — especially one that is seeking government business.”
ACTION ALERT: Comments Needed on Important Language Access Standard by July 25
Posted in Advocacy, Consumer Protection, Discrimination, Economics of Health Care, Health Care Marketing, Health Care Reform, Health Insurance, Health Literacy, Language Access, Language Services on 20 July 2011 | Leave a Comment »
Several national health advocacy groups have put out an alert about some key changes to language access standards that have just been proposed for the communication responsibilities of certain federal agencies which regulate private health care plans. As we move forward towards the enactment of health care reform, it is critical that everyone, including LEP individuals, have the same rights to get access to to plan information and help with insurance appeals. Health insurance is of course a critical part of access to health care and thus of any individual’s health status. Communication is an essential part of health and health care. Lack of communication access causes both personal harm and contributes to health inequalities between population groups, plus drives up health care costs for people and systems. If the new proposed standards are enacted, they would roll back current rules which private insurance companies must follow to ensure language access for plan beneficiaries.
What you can do: there is a very short window of opportunity now available for individuals and organizations to voice their concerns by submitting comments online to the federal government via a dedicated website. The deadline for submissions is 2 p.m, PDT, on Monday July 25 !
For details about this critical issue, and instructions on how to submit comments along with suggested language, please read the following memo from the National Senior Citizens Law Center (NSCLC), the Asian Pacific American Legal Center (APALC), and the National Health Law Program (NHeLP):
URGENT: Comments Needed on Important Language Access Standard
NSCLC, APALC and NHeLP asking advocates to submit by July 25
IMPORTANT: Please provide comments to the Centers for Medicare and Medicaid Services (CMS), Internal Revenue Service (IRS) and the Department of Labor (DOL) on proposed regulations governing private health care plans. The regulations as proposed are a significant step backward from the version issued in 2010 and affect about 12 million individuals. They change the existing standards for oral interpretation and written translation in unprecedented ways. Please send in comments now and urge colleagues and networks to also take action.
The deadline for submitting comments to CMS on this proposed rule is 5 pm Eastern Time on Monday, July 25, 2011.
The National Senior Citizens Law Center (NSCLC), the Asian Pacific American Legal Center (APALC), and the National Health Law Program (NHeLP) urge you to submit comments using the guidelines below. Then, please spread the word to your listservs, networks, colleagues, and affected beneficiaries, near and far, who may care about language access issues!
Issue: CMS, IRS and the DOL’s Employee Benefits Security Administration (EBSA) have jointly issued regulations governing the internal claims and appeals and external review processes for private group health plans and health insurance issuers (note: this does not directly impact Medicare and Medicaid plans).
These rules were first promulgated as interim final regulations in June 2010, and were relatively strong. After industry complaints, they were amended as of July 2011, and significantly watered down. The public has this opportunity to comment.
Here are the three major language access issues relating to internal claims and appeals and external review:
- Written translations for group health plans: The threshold for determining whether translation of vital documents is required is set at: 10% of county population for group health plans. Formerly this was at 10% of plan participants in a given language or 500 persons, whichever is less; where a group plan has less than 100 participants, 25% was used.
- Written translations for individual plans: The threshold for this group is also 10% of county population. This was set based on the Medicare Part C and D marketing regulation (a proposal that has since been changed as of 4/15/11 to 5%, as a result of many persons submitting comments against the 10%).
- Oral interpretation: Although it has been well settled that civil rights law mandates that oral interpretation should be provided in the health and health insurance contexts for all languages, the proposed regulations set a new precedent and require oral interpretation ONLY in the languages that meet the 10% threshold. This is a major issue that needs to be addressed.
The new proposed standards completely fail to recognize the needs of the approximately 12 million limited English proficient individuals in the United States that are estimated to be affected by these regulations. Many of these individuals may receive marketing materials and calls in their primary languages, but will not be able to access plan review and appeals under the new rules. Even Spanish speakers will be left out in most of the country, as only 172 counties meet the 10% county population threshold for Spanish (out of 3,143 counties in the United States). Besides Spanish, the new proposed translation threshold is met by Navajo in 3 counties (1 county each in AZ, NM, UT), Tagalog in 2 counties (both in AK), and Chinese in one county (CA). Only 177 counties would require translated materials. Only one county in the entire nation would have translations in more than one language: the Aleutians West Census Area (population of 5,505 total persons) would have Spanish and Tagalog translations.
We need everyone – even advocates that don’t usually work on private insurance issues and those who have never commented on a federal rule – to take action now.
What You Can Do:
1. FILE COMMENTS:
a) Go to www.regulations.gov
b) Enter keyword or ID as “group plan” and hit the “SEARCH” button
c) Scroll down and choose “Group Health Plans and Health Insurance Issuers: Internal Claims and Appeals and External Review Processes” and click on “submit a comment” on right side
d) Although the regulation is proposed by three agencies, you only need to submit once. The agencies will share the information.
e) Paste in the comments below and edit them, or write your own, then “Submit.”
f) You are not required to fill out other fields, although it may be helpful to provide your affiliation. If you wish, you may be anonymous. Comments submitted are viewable online (after a processing period) by the general public.
SAMPLE COMMENT:
On behalf of [organization/myself], I wish to comment on the 10% threshold for translation and oral interpretation of private plan materials in the internal review and appeals contexts. I am… [add 1-2 sentences about yourself, organization or work with LEP individuals]. The 10% standard is far too high. A more appropriate standard would be “5% of the plan’s population or 500 persons in plan’s service area, whichever is less” for large group plans, and 25% of population for small plans. Oral interpretation should be provided in all languages at all times. {Consider adding information about the impact on your clients when they cannot get documents in a language that they understand.}
2. Forward this email to all of your contacts – other advocates, providers, interpreters, beneficiaries affected, and urge them to also file comments. The more comments filed, the more CMS/IRS/EBSA are likely to pay serious attention to this issue.
3. If you are bilingual or work with LEP populations, consider having them file comments in other languages as well as in English, for impact.
For more information about commenting and the proposed regulations, see www.nsclc.org and www.healthlaw.org . Please feel free to submit detailed comments if you prefer.
Katharine Hsiao khsiao@nsclc.org
Georgia Burke gburke@nsclc.org
Kevin Prindiville kprindiville@nsclc.org
Mara Youdelman youdelman@healthlaw.org
Doreena Wong dwong@apalc.org
Headline Scan
Posted in Access to Medicines, Advocacy, Assistance, Children's Health, Economics of Health Care, Environmental Health, Ethics, Global Health, Health Care Marketing, Health Disparities, Health Insurance, Health Literacy, Healthcare Inequalities, Language Access, Recession, State of Washington, Workers' rights on 18 May 2011 | Leave a Comment »
Can We Afford Personalized Medicine?
Special treatment for ‘high profile’ patients; exasperation for the rest of us
Health Insurers Making Record Profits as Many Postpone Care
People Who Donate Organs For Transplants Can Have Difficulty Getting Insurance
Foundations, Conflicts Of Interest And Drugmakers
Mission Crash: The Intolerable Policy Incoherence in US AIDS Policy, Global and Domestic
Office of Minority Health Awards Major Project to Support
CCHI’s work on Healthcare Interpreter Certification
WA Governor signs precedent-setting healthcare worker safety laws
Washington is first state in nation to ban toxic pavement sealants
HHS awards $4.9 million to support families of children with special health care needs
Local and Noteworthy
Posted in Health Care Marketing on 28 April 2011 | Leave a Comment »
Free Health Clinic for the Uninsured at the Tacoma Dome on April 30. The National Association of Free Clinics (NAFC), in partnership with the Washington Free Clinic Association, (WFCA) will be holding a one-day free clinic on Saturday, April 30, 2011 in the Tacoma Dome. The upcoming C.A.R.E. (Communities Are Responding Everyday) Clinic will offer free primary and preventative health care services to an estimated 1,200 uninsured adult residents of the Seattle-Tacoma area. Appointments are required and can be made by calling 1-877-233-5159 toll free. Volunteer clinicians are still needed and can sign up on the NAFC website.
Microsoft changes disability policy following KING 5 report. Microsoft announced today that it is changing its short-term disability policy, following a KING 5 News report about the employee who was denied paid leave to undergo surgery for a brain tumor. According to the new report, the company now says it will pay its employees short-term disability regardless of their performance reviews, effective immediately.
The DEA’s Second National Prescription Drug Take-Back Day will include sites across Washington State. For one day only, April 30, unused medicines can be disposed of between the hours 10 a.m. – 2 p.m. of at locations around the state. But there is more to the issue than a one-time event or quick fixes. Prime-time TV ads for the event, sponsored by SMARxTDisposal, a project of the U.S. Fish and Wildlife Service, the American Pharmacists Association, and the Pharmaceutical Research and Manufacturers of America also advise how to dispose of drugs year-round. The solution they offer is to mix the meds with household waste and water in plastic zipper bags, them tossing in the trash. Getting medicines out of circulation before they can be used or abused for recreational and/or criminal purposes , and contaminate our groundwaters is a serious concern. But for three years running, pharma lobbying has succeeded in defeating bills in Washington State that would have created a permanent medicine take-back program. Modeled after programs in Europe and Canada ( including in neighboring British Columbia) supported by small fees from the pharmaceutical industry, the WA bills had broad support from law enforcement agencies, local governments, health care professionals, environmental groups and substance abuse prevention programs. The Take Back Your Meds coalition lists a few temporary current Rx drop-off locations, and has vowed to keep up the fight. 
Breaking News: Washington State Medicaid program to retain medical interpreter services until June 30
Posted in Health Care Marketing on 18 February 2011 | Leave a Comment »
Here’s link for the press release issued this afternoon:
The advocacy work is far from done, but the temporary reprieve buys time for making plans for an updated, more cost-effective program.
News Roundup
Posted in Health Care Marketing on 4 February 2011 | Leave a Comment »
Awaiting Health Law’s Prognosis
Free diabetes and blood pressure drugs for Brazilians
Publishers cut off doctors’ free access to medical journals in poor countries
Medical check ups by phone ring up savings
Health Peru: Cost of Medicines Out of Control
Celgene Forced To Disclose Pricing Data To Canada
New reports:
The High Costs of Language Barriers in Medical Malpractice
New State Scorecard on Children’s Health Care Finds Wide Geographic Disparities
Rx Money Saving Ideas for States and Federal Government? Guess Again
Posted in Health Care Marketing on 31 January 2011 | Leave a Comment »
One might think that a report entitled Potential Federal and State-by-State Savings if Medicaid Pharmacy Programs Were Optimally Managed could contain useful information for cash-strapped states and the federal government. When the report was released last month by author The Lewin Group, the consulting firm issued a press release stating that
But when the National Community Pharmacists Association reviewed the report, they found many reasons to be concerned both about transparency and COI issues with Lewin and the contents of the report itself. NPCA’s Associate Director John Norton enumerated these problems in his recent blog post entitled Lewin Group/PBMs’ Medicaid Pharmacy Report Misses the Mark; Recommendations Threaten Patient Health and Access. Among the concerns highlighted are:
- ….the Lewin Group’s website touts itself as an “independent” consultant for clients, including the PBMs’ trade group, which commissioned this study. In this instance, that independence claim is undermined by the fact that the Lewin Group is owned by United HealthCare, a health care conglomerate whose holdings include Prescription Solutions— a PBM that serves over 10 million people.
- PBMs have a record of questionable business practices, including in the states which they now purport to “save.”
- By law, Medicaid programs must get the manufacturer’s best price for a particular drug. PBMs simply cannot negotiate better prices for drugs than Medicaid. Moreover, PBMs are notorious for not adequately sharing rebates from manufacturers.
- The Lewin Group focuses on the savings that could be realized by moving a specific disability category—the blind and disabled—into managed care, citing the fact that this population experiences a high per-capita pharmacy cost. However, the Center for Health Care Strategies rejected this idea….
- PBMs would charge the states massive administrative costs as compared to existing state Medicaid programs, which are run more efficiently through fiscal intermediaries. This means that states would spend more money on bloated PBM middlemen rather than patient care.
- The study ignores the potential loss of jobs and tax revenues to the state by driving Medicaid prescription revenues to out-of-state PBMs;
- PBMs seek to also achieve massive savings by reducing access to prescription drugs and services provided by community pharmacies.
NPCA issued its own analysis of the findings: Lewin’s Medicaid Pharmacy Managed Care Report: Bought and Paid for by PBMs .
The Michigan Pharmacists Association also spoke out against the misleading report, debunking its claims that
What’s been the response in your state to this report ? Readers, please let me know.
